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. 2021 Oct 12;13(10):e18717.
doi: 10.7759/cureus.18717. eCollection 2021 Oct.

CovHos, a New Score to Predict the Need of Hospitalization for Coronavirus Disease 2019 (COVID-19) Patients at the Emergency Department

Veronica Salvatore  1 , Alice Gianstefani  1 , Gabriele Farina  1 , Ilaria Carletti  1 , Nicoletta Carpentieri  1 , Anna Laura Tinuper  1 , Francesca Trabalza  1 , Alice Grignaschi  1 , Fabrizio Giostra  1
Affiliations

CovHos, a New Score to Predict the Need of Hospitalization for Coronavirus Disease 2019 (COVID-19) Patients at the Emergency Department

Veronica Salvatore et al. Cureus. .

Abstract

Introduction and aim: As first receivers of suspected coronavirus disease 2019 (COVID-19) patients, clinicians of the Emergency Department (ED) have to rapidly perform the first clinical assessment evaluating the intensity of care needed. So far, clear management guidelines still lack. We identified variables associated with hospitalization in order to give a quick tool to assist clinicians in stratifying cases based on the severity at their arrival at the ED and in predicting the need for hospital care. Methods: This is a monocentric observational prospective study enrolling COVID-19 patients. A score for hospitalization prediction (CovHos Score) was created using variables associated with hospitalization at multivariate analysis and then validated on an internal subsequent cohort.

Results: A total of 667 patients were included; 465 (69.7%) were hospitalized and 108 (16.2%) died at 30-days follow-up. In a multivariate analysis, male sex, age>65, alveolar-to-arterial oxygen gradient percentage increase compared to that expected for age, neutrophils/lymphocytes ratio and C-reactive protein levels were significantly associated with a higher rate of hospital admission. A CovHos score cut-off of 12 points predicted hospitalization with 85% sensitivity and 82.4 % specificity (area under a receiver operating characteristic curve [AUROC] = 0.909, 95% CI 0.884 - 0.935). Similar results were obtained in the validation court. A cut-off of 22 has 79% sensitivity and 77% specificity in predicting mortality (AUROC = 0.824; 95% CI 0.782-0.866); sensitivity and specificity were respectively 71.4% and 71.3% in the validation group.

Conclusions: Although medical judgment still remains crucial, the CovHos score is an effective tool to assist emergency clinicians in predicting the need for hospitalization or to optimize allocation in a shortage of hospital resources.

Keywords: coronavirus; covid-19; discharge; emergency department; score.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Receiver operating characteristic (ROC) analysis of CovHos Score in predicting hospitalization in COVID-19 patients
Figure 2
Figure 2. Receiver operating characteristic (ROC) analysis of CovHos Score in the validation group
Figure 3
Figure 3. Examples of CovHos score application
AaDO2 = Alveolar-to-arterial Oxygen Gradient; y = years
See this image and copyright information in PMC

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